Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 04986 | Date 25/10/2021 |
| Token No | SM/21-22/1273 25/10/2021 | Serial | 011 |
| Patient Name | Mrs. KALPANA MAHATO | Contact No | NOT GIVEN |
| Address | 3 BARAL BAGAN | Age | 65 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||